Business License Application revised 3.28.19 final - Stockton
FOR OFFICE USE ONLY: TAX ACCT. #
CONTROL #
SMC
CLASS
SINC
BOE
ADMINISTRATIVE SERVICES DEPARTMENT REVENUE SERVICES DIVISION?BUSINESS LICENSE TAX 425 North El Dorado Street ? PO Box 1570 ? Stockton, CA ? 95201
Phone (209) 937-8313 Fax (209) 937-7184 Email: bl@
BUSINESS LICENSE TAX APPLICATION
NEW LIC CHANGE
Number of Employees: Full Time Change From
Part Time
Temporary
Square Footage
Date of Change
Bus Lic #
NOTE: Any change in ownership, address, or business activity, requires a new application. The City of Stockton does not guarantee that information on this form will be exempt from disclosure under the Public Records Act.
**ALTERED OR INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED**
BUSINESS INFORMATION: 1. Business Name (DBA)
Phone ( )
2. Business Address
Ste/Apt # City
State Zip
(Cannot be PO Box per CA Bus & Prof Code Section 17538.5) (List address where each individual consent to receive service of process AB2184 Sec 1600)
3. Business Mailing Address
(If different from the service process address/Business address)
Ste/Apt # City
4. Business Email Address
5. Business involved in renting residential or commercial real estate (Stockton only):
State Zip
Property Address
Property Owner
Parcel #
6. Detail Description of Business Activity
7. Are you Chamber of Commerce Green Certified? Yes No___ (For information contact Chamber of Commerce (209) 547-2770)
8. Start date in the City of Stockton
Estimated Monthly Gross Receipts in Stockton $
9. Contractor's only: Project Amount
Classification
Expiration Date
CA Contractor's License #
Annual Quarterly Contractors License
10. Seller's Permit #
SS# or Tax ID #
11. Check One: Single Owner Partnership Corporation LP LLC
OWNER(S) INFORMATION: (The following personal information is not public and will not be shared in accordance with city policy OL-103.) Proof of
compliance with Business and Professions Code Section 17538.5(b)(2)(A)(B) may be submitted in lieu of home address
1. Name
Address
City
State
Zip
Home Phone ( )
Date of Birth
Driver's Lic or Other I.D.#
State
2. Name City Date of Birth
Address
State
Zip
Driver's Lic or Other I.D.#
Home Phone (
) State
FOR OFFICE USE ONLY: TAX ACCT. #
Page 2
CONTROL #
CORPORATION, LLC, or LP INFORMATION: Name (Must be Registered in California) Names of Officers/Members
President:
Corp/LLC/LP # Secretary:
Vice President:
Treasurer:
Authorized Agent:
Contact Phone #
Authorized Agent:
Contact Phone #
PLEASE NOTE:
The Issuing of your Business License is for revenue purposes only. It does not relieve you from the responsibility of complying with the requirements of any other department of the City of Stockton and/or any other ordinance, law or regulation of the City of Stockton, State of California, or any other governmental agency.
Business Licenses are not transferable. It is your responsibility to renew your Business License whether or not you receive a renewal notice. If you are no longer conducting business in the City of Stockton, you must notify us in writing. To appeal a business license that has been denied see SMC 5.04.210.A
I HAVE READ AND UNDERSTAND THE TERMS ABOVE ? I HEREBY CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION PROVIDED ON THIS APPLICATION IS TRUE AND CORRECT.
Owner/Authorized Signature
Title
Date
Owner/Authorized Signature
Title
Date
Disability Access and Education Fee (SB 1186)
**State Mandated Disability Access and Education Revolving Fund. Under federal and state law, compliance with disability access laws is a serious and significant responsibility that applies to all California building owners and tenants with buildings open to the public. You may obtain information about your legal obligations and how to comply with disability access laws at the following agencies:
o The Division of the State Architect at dgs.dsa/Home.aspx. o The Department of Rehabilitation at rehab.. o The California Commission on Disability Access at da..
FOR OFFICE USE ONLY Processed By:
Date:
Business License Taxes/Fees
Amount
Dept/Div Checked Must Approve or Deny
Authorized Signature and Date
Registration Tax
$24.00
Planning
Approved Denied
Mill Tax/Flat Rate Tax
Building
Approved Denied
Penalty
Fire Police Other:
Approved Denied Approved Denied Approved Denied
Prior Year(s) Taxes
**State Mandated Disability Access and Education Revolving Fund
Total Due
$4.00
Expiration Date
PLEASE RETAIN A COPY FOR YOUR RECORDS
Revised 8/28/2019
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